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Clinical and biochemical manifestations of Cushing’s

Pituitary volume 18, pages 181–187 (2015)Cite this article

Abstract

Introduction

Cushing’s syndrome is associated with a number of clinical manifestations and co-morbidities which may not resolve even after long-term remission leading to excessive mortality.

Materials and methods

This review summarizes the main manifestations of Cushing’s syndrome (active or in remission) with particular focus on data from recently published literature.

Conclusion

Obesity and metabolic alterations, hypertension and cardio/cerebrovascular complications, hypercoagulability/thromboembolism, neuropsychiatric, muscle/skeletal and immune consequences remain the most challenging. Cardiovascular consequences and immunosuppression determine the main causes of death in Cushing’s syndrome necessitating early intervention when possible.

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References

  1. Ntali G, Asimakopoulou A, Siamatras T, Komninos J, Vassiliadi D, Tzanela M, Tsagarakis S, Grossman AB, Wass JA, Karavitaki N (2013) Mortality in Cushing’s syndrome: systematic analysis of a large series with prolonged follow-up. Eur J Endocrinol 169:715–723

    Article  CAS  PubMed  Google Scholar 

  2. Yaneva M, Kalinov K, Zacharieva S (2013) Mortality in Cushing’s syndrome: data from 386 patients from a single tertiary referral center. Eur J Endocrinol 169:621–627

    Article  CAS  PubMed  Google Scholar 

  3. Hassan-Smith ZK, Sherlock M, Reulen RC, Arlt W, Ayuk J, Toogood AA, Cooper MS, Johnson AP, Stewart PM (2012) Outcome of Cushing’s disease following transsphenoidal surgery in a single center over 20 years. J Clin Endocrinol Metab 97:1194–1201

    Article  CAS  PubMed  Google Scholar 

  4. Clayton RN, Raskauskiene D, Reulen RC, Jones PW (2011) Mortality and morbidity in Cushing’s disease over 50 years in Stoke-on-Trent, UK: audit and meta-analysis of literature. J Clin Endocrinol Metab 96:632–642

    Article  CAS  PubMed  Google Scholar 

  5. Valassi E, Santos A, Yaneva M, Tóth M, Strasburger CJ, Chanson P, Wass JA, Chabre O, Pfeifer M, Feelders RA, Tsagarakis S, Trainer PJ, Franz H, Zopf K, Zacharieva S, Lamberts SW, Tabarin A, Webb SM, ERCUSYN Study Group (2011) The European Registry on Cushing’s syndrome: 2-year experience. Baseline demographic and clinical characteristics. Eur J Endocrinol 165:383–392

    Article  CAS  PubMed  Google Scholar 

  6. Geer EB, Shen W, Gallagher D, Punyanitya M, Looker HC, Post KD, Freda PU (2010) MRI assessment of lean and adipose tissue distribution in female patients with Cushing’s disease. Clin Endocrinol 73:469–475

    Google Scholar 

  7. Kola B, Christ-Crain M, Lolli F, Arnaldi G, Giacchetti G, Boscaro M, Grossman AB, Korbonits M (2008) Changes in adenosine 5′-monophosphate-activated protein kinase as a mechanism of visceral obesity in Cushing’s syndrome. J Clin Endocrinol Metab 93:4969–4973

    Article  CAS  PubMed  Google Scholar 

  8. Geer EB, Shen W, Strohmayer E, Post KD, Freda PU (2012) Body composition and cardiovascular risk markers after remission of Cushing’s disease: a prospective study using whole-body MRI. J Clin Endocrinol Metab 97:1702–1711

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Libè R, Morpurgo PS, Cappiello V, Maffini A, Bondioni S, Locatelli M, Zavanone M, Beck-Peccoz P, Spada A (2005) Ghrelin and adiponectin in patients with Cushing’s disease before and after successful transsphenoidal surgery. Clin Endocrinol 62:30–36

    Article  Google Scholar 

  10. Veldman RG, Frölich M, Pincus SM, Veldhuis JD, Roelfsema F (2001) Hyperleptinemia in women with Cushing’s disease is driven by high-amplitude pulsatile, but orderly and eurhythmic, leptin secretion. Eur J Endocrinol 144:21–27

    Article  CAS  PubMed  Google Scholar 

  11. Krsek M, Silha JV, Jezková J, Hána V, Marek J, Weiss V, Stepán JJ, Murphy LJ (2004) Adipokine levels in Cushing’s syndrome; elevated resistin levels in female patients with Cushing’s syndrome. Clin Endocrinol 60:350–357

    Article  CAS  Google Scholar 

  12. Setola E, Losa M, Lanzi R, Lucotti P, Monti LD, Castrignanò T, Galluccio E, Giovanelli M, Piatti P (2007) Increased insulin-stimulated endothelin-1 release is a distinct vascular phenotype distinguishing Cushing’s disease from metabolic syndrome. Clin Endocrinol 66:586–592

    CAS  Google Scholar 

  13. Barahona MJ, Sucunza N, Resmini E, Fernández-Real JM, Ricart W, Moreno-Navarrete JM, Puig T, Farrerons J, Webb SM (2009) Persistent body fat mass and inflammatory marker increases after long-term cure of Cushing’s syndrome. J Clin Endocrinol Metab 94:3365–3371

    Article  CAS  PubMed  Google Scholar 

  14. Valassi E, Biller BM, Klibanski A, Misra M (2012) Adipokines and cardiovascular risk in Cushing’s syndrome. Neuroendocrinology 95:187–206

    Article  CAS  PubMed  Google Scholar 

  15. Mancini T, Kola B, Mantero F, Boscaro M, Arnaldi G (2004) High cardiovascular risk in patients with Cushing’s syndrome according to 1999 WHO/ISH guidelines. Clin Endocrinol 61:768–777

    Article  Google Scholar 

  16. Giordano R, Picu A, Marinazzo E, D’Angelo V, Berardelli R, Karamouzis I, Forno D, Zinnà D, Maccario M, Ghigo E, Arvat E (2011) Metabolic and cardiovascular outcomes in patients with Cushing’s syndrome of different aetiologies during active disease and 1 year after remission. Clin Endocrinol 75:354–360

    Article  CAS  Google Scholar 

  17. Colao A, Pivonello R, Spiezia S, Faggiano A, Ferone D, Filippella M, Marzullo P, Cerbone G, Siciliani M, Lombardi G (1999) Persistence of increased cardiovascular risk in patients with Cushing’s disease after 5 years of successful cure. J Clin Endocrinol Metab 84:2664–2672

    CAS  PubMed  Google Scholar 

  18. Arnaldi G, Scandali VM, Trementino L, Cardinaletti M, Appolloni G, Boscaro M (2010) Pathophysiology of dyslipidemia in Cushing’s syndrome. Neuroendocrinology 92(suppl. 1):86–90

    Article  CAS  PubMed  Google Scholar 

  19. Giordano C, Guarnotta V, Pivonello R, Amato MC, Simeoli C, Ciresi A, Cozzolino A, Colao A (2013) Is diabetes in Cushing’s syndrome only a consequence of hypercortisolism? Eur J Endocrinol 170:311–319

    Article  PubMed  Google Scholar 

  20. Lambert JK, Goldberg L, Fayngold S, Kostadinov J, Post KD, Geer EB (2013) Predictors of mortality and long-term outcomes in treated Cushing’s disease: a study of 346 patients. J Clin Endocrinol Metab 98:1022–1030

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Mazziotti G, Gazzaruso C, Giustina A (2011) Diabetes in Cushing syndrome: basic and clinical aspects. Trends Endocrinol Metab 22:499–506

    Article  CAS  PubMed  Google Scholar 

  22. Cicala MV, Mantero F (2010) Hypertension in Cushing’s syndrome: from pathogenesis to treatment. Neuroendocrinology 92(suppl. 1):44–49

    Article  CAS  PubMed  Google Scholar 

  23. Kirilov G, Tomova A, Dakovska L, Kumanov P, Shinkov A, Alexandrov AS (2003) Elevated plasma endothelin as an additional cardiovascular risk factor in patients with Cushing’s syndrome. Eur J Endocrinol 149:549–553

    Article  CAS  PubMed  Google Scholar 

  24. Boscaro M, Sonino N, Scarda A, Barzon L, Fallo F, Sartori MT, Patrassi GM, Girolami A (2002) Anticoagulant prophylaxis markedly reduces thromboembolic complications in Cushing’s syndrome. J Clin Endocrinol Metab 87:3662–3666

    CAS  PubMed  Google Scholar 

  25. Manetti L, Bogazzi F, Giovannetti C, Raffaelli V, Genovesi M, Pellegrini G, Ruocco L, Iannelli A, Martino E (2010) Changes in coagulation indexes and occurrence of venous thromboembolism in patients with Cushing’s syndrome: results from a prospective study before and after surgery. Eur J Endocrinol 163:783–791

    Article  CAS  PubMed  Google Scholar 

  26. Van der Pas R, Leebeek FW, Hofland LJ, de Herder WW, Feelders RA (2013) Hypercoagulability in Cushing’s syndrome: prevalence, pathogenesis and treatment. Clin Endocrinol 78:481–488

    Article  Google Scholar 

  27. Dusek T, Kastelan D, Solak M, Basic Kinda S, Aganovic I, Korsic M (2008) Polycythemia as the first manifestation of Cushing’s disease. J Endocrinol Invest 31:940

    Article  CAS  PubMed  Google Scholar 

  28. Miljic P, Miljic D, Cain JW, Korbonits M, Popovic V (2012) Pathogenesis of vascular complications in Cushing’s syndrome. Hormones 11:21–30

    PubMed  Google Scholar 

  29. Stuijver DJ, Van Zaane B, Feelders RA, Debeij J, Cannegieter SC, Hermus AR, van den Berg G, Pereira AM, de Herder WW, Wagenmakers MA, Kerstens MN, Zelissen PM, Fliers E, Schaper N, Drent ML, Dekkers OM, Gerdes VE (2011) Incidence of venous thromboembolism in patients with Cushing’s syndrome: a multicenter cohort study. J Clin Endocrinol Metab 96:3525–3532

    Article  CAS  PubMed  Google Scholar 

  30. Van Zaane B, Nur E, Squizzato A, Dekkers OM, Twickler MT, Fliers E, Gerdes VE, Büller HR, Brandjes DP (2009) Hypercoagulable state in Cushing’s syndrome: a systematic review. J Clin Endocrinol Metab 94:2743–2750

    Article  PubMed  Google Scholar 

  31. Kastelan D, Dusek T, Kraljevic I, Aganovic I (2013) Hypercoagulable state in Cushing’s syndrome is reversible following remission. Clin Endocrinol 78:102–106

    Article  CAS  Google Scholar 

  32. van der Pas R, de Bruin C, Leebeek FW, de Maat MP, Rijken DC, Pereira AM, Romijn JA, Netea-Maier RT, Hermus AR, Zelissen PM, de Jong FH, van der Lely AJ, de Herder WW, Lamberts SW, Hofland LJ, Feelders RA (2012) The hypercoagulable state in Cushing’s disease is associated with increased levels of procoagulant factors and impaired fibrinolysis, but is not reversible after short-term biochemical remission induced by medical therapy. J Clin Endocrinol Metab 97:1303–1310

    Article  PubMed  Google Scholar 

  33. Dekkers OM, Horváth-Puhó E, Jørgensen JO, Cannegieter SC, Ehrenstein V, Vandenbroucke JP, Pereira AM, Sørensen HT (2013) Multisystem morbidity and mortality in Cushing’s syndrome: a cohort study. J Clin Endocrinol Metab 98:2277–2284

    Article  CAS  PubMed  Google Scholar 

  34. Alexandraki KI, Kaltsas GA, Vouliotis AI, Papaioannou TG, Trisk L, Zilos A, Korbonits M, Besser GM, Anastasakis A, Grossman AB (2011) Specific electrocardiographic features associated with Cushing’s disease. Clin Endocrinol 74:558–564

    Article  Google Scholar 

  35. Toja PM, Branzi G, Ciambellotti F, Radaelli P, De Martin M, Lonati LM, Scacchi M, Parati G, Cavagnini F, Pecori Giraldi F (2012) Clinical relevance of cardiac structure and function abnormalities in patients with Cushing’s syndrome before and after cure. Clin Endocrinol 76:332–338

    Article  CAS  Google Scholar 

  36. Pereira AM, Delgado V, Romijn JA, Smit JW, Bax JJ, Feelders RA (2010) Cardiac dysfunction is reversed upon successful treatment of Cushing’s syndrome. Eur J Endocrinol 162:331–340

    Article  CAS  PubMed  Google Scholar 

  37. Yiu KH, Marsan NA, Delgado V, Biermasz NR, Holman ER, Smit JW, Feelders RA, Bax JJ, Pereira AM (2012) Increased myocardial fibrosis and left ventricular dysfunction in Cushing’s syndrome. Eur J Endocrinol 166:27–34

    Article  CAS  PubMed  Google Scholar 

  38. Hey TM, Dahl JS, Brix TH, Søndergaard EV (2013) Biventricular hypertrophy and heart failure as initial presentation of Cushing’s disease. BMJ Case Rep. doi:10.1136/bcr-2013-201307

    PubMed  Google Scholar 

  39. Rotondi M, Dionisio R, Fonte R, Caporotondi A, Guazzotti G, Baccheschi J, Febo O, Castellano M, Chiovato L (2011) Dilated cardiomyopathy: a possibly underestimated presentation of Cushing’s disease. Clin Endocrinol 75:864–865

    Article  Google Scholar 

  40. Chandran DS, Ali N, Jaryal AK, Jyotsna VP, Deepak KK (2013) Decreased autonomic modulation of heart rate and altered cardiac sympathovagal balance in patients with Cushing’s syndrome: role of endogenous hypercortisolism. Neuroendocrinology 97:309–317

    Article  CAS  PubMed  Google Scholar 

  41. Jyotsna VP, Naseer A, Sreenivas V, Gupta N, Deepak KK (2011) Effect of Cushing’s syndrome—endogenous hypercortisolemia on cardiovascular autonomic functions. Auton Neurosci 160:99–102

    Article  CAS  PubMed  Google Scholar 

  42. Faggiano A, Pivonello R, Spiezia S, De Martino MC, Filippella M, Di Somma C, Lombardi G, Colao A (2003) Cardiovascular risk factors and common carotid artery caliber and stiffness in patients with Cushing’s disease during active disease and 1 year after disease remission. J Clin Endocrinol Metab 88:2527–2533

    Article  CAS  PubMed  Google Scholar 

  43. Albiger N, Testa RM, Almoto B, Ferrari M, Bilora F, Petrobelli F, Pagnan A, Mantero F, Scaroni C (2006) Patients with Cushing’s syndrome have increased intimal media thickness at different vascular levels: comparison with a population matched for similar cardiovascular risk factors. Horm Metab Res 38:405–410

    Article  CAS  PubMed  Google Scholar 

  44. Fallo F, Famoso G, Capizzi D, Sonino N, Dassie F, Maffei P, Martini C, Paoletta A, Iliceto S, Tona F (2013) Coronary microvascular function in patients with Cushing’s syndrome. Endocrine 43:206–213

    Article  CAS  PubMed  Google Scholar 

  45. Rizzoni D, Porteri E, De Ciuceis C, Rodella LF, Paiardi S, Rizzardi N, Platto C, Boari GE, Pilu A, Tiberio GA, Giulini SM, Favero G, Rezzani R, Rosei CA, Bulgari G, Avanzi D, Rosei EA (2009) Hypertrophic remodeling of subcutaneous small resistance arteries in patients with Cushing’s syndrome. J Clin Endocrinol Metab 94:5010–5018

    Article  CAS  PubMed  Google Scholar 

  46. Barahona MJ, Resmini E, Viladés D, Pons-Lladó G, Leta R, Puig T, Webb SM (2013) Coronary artery disease detected by multislice computed tomography in patients after long-term cure of Cushing’s syndrome. J Clin Endocrinol Metab 98:1093–1099

    Article  CAS  PubMed  Google Scholar 

  47. Bourdeau I, Bard C, Noël B, Leclerc I, Cordeau MP, Bélair M, Lesage J, Lafontaine L, Lacroix A (2002) Loss of brain volume in endogenous Cushing’s syndrome and its reversibility after correction of hypercortisolism. J Clin Endocrinol Metab 87:1949–1954

    CAS  PubMed  Google Scholar 

  48. Starkman MN, Gebarski SS, Berent S, Schteingart DE (1992) Hippocampal formation volume, memory dysfunction, and cortisol levels in patients with Cushing’s syndrome. Biol Psychiatry 32:756–765

    Article  CAS  PubMed  Google Scholar 

  49. Dimopoulou C, Ising M, Pfister H, Schopohl J, Stalla GK, Sievers C (2013) Increased prevalence of anxiety-associated personality traits in patients with Cushing’s disease: a cross-sectional study. Neuroendocrinology 97:139–145

    Article  CAS  PubMed  Google Scholar 

  50. Langenecker SA, Weisenbach SL, Giordani B, Briceño EM, Guidotti Breting LM, Schallmo MP, Leon HM, Noll DC, Zubieta JK, Schteingart DE, Starkman MN (2012) Impact of chronic hypercortisolemia on affective processing. Neuropharmacology 62:217–225

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  51. Toffanin T, Nifosì F, Follador H, Passamani A, Zonta F, Ferri G, Scanarini M, Amistà P, Pigato G, Scaroni C, Mantero F, Carollo C, Perini GI (2011) Volumetric MRI analysis of hippocampal subregions in Cushing’s disease: a model for glucocorticoid neural modulation. Eur Psychiatry 26:64–67

    Article  CAS  PubMed  Google Scholar 

  52. Starkman MN, Giordani B, Gebarski SS, Berent S, Schork MA, Schteingart DE (1999) Decrease in cortisol reverses human hippocampal atrophy following treatment of Cushing’s disease. Biol Psychiatry 46:1595–1602

    Article  CAS  PubMed  Google Scholar 

  53. Starkman MN, Giordani B, Gebarski SS, Schteingart DE (2007) Improvement in mood and ideation associated with increase in right caudate volume. J Affect Disord 101:139–147

    Article  PubMed  Google Scholar 

  54. Starkman MN, Giordani B, Gebarski SS, Schteingart DE (2003) Improvement in learning associated with increase in hippocampal formation volume. Biol Psychiatry 53:233–238

    Article  PubMed  Google Scholar 

  55. Hook JN, Giordani B, Schteingart DE, Guire K, Giles J, Ryan K, Gebarski SS, Langenecker SA, Starkman MN (2007) Patterns of cognitive change over time and relationship to age following successful treatment of Cushing’s disease. J Int Neuropsychol Soc 13:21–29

    Article  PubMed  Google Scholar 

  56. Resmini E, Santos A, Gómez-Anson B, Vives Y, Pires P, Crespo I, Portella MJ, de Juan-Delago M, Barahona MJ, Webb SM (2012) Verbal and visual memory performance and hippocampal volumes, measured by 3-Tesla magnetic resonance imaging, in patients with Cushing’s syndrome. J Clin Endocrinol Metab 97:663–671

    Article  CAS  PubMed  Google Scholar 

  57. Resmini E, Santos A, Gómez-Anson B, López-Mourelo O, Pires P, Vives-Gilabert Y, Crespo I, Portella MJ, de Juan-Delago M, Webb SM (2013) Hippocampal dysfunction in cured Cushing’s syndrome patients, detected by (1) H-MR-spectroscopy. Clin Endocrinol 79:700–707

    CAS  Google Scholar 

  58. Andela CD, van der Werff SJ, Pannekoek JN, van den Berg SM, Meijer OC, van Buchem MA, Rombouts SA, van der Mast RC, Romijn JA, Tiemensma J, Biermasz NR, van der Wee NJ, Pereira AM (2013) Smaller grey matter volumes in the anterior cingulate cortex and greater cerebellar volumes in patients with long-term remission of Cushing’s disease: a case-control study. Eur J Endocrinol 169:811–819

    Article  CAS  PubMed  Google Scholar 

  59. Tiemensma J, Biermasz NR, Middelkoop HA, van der Mast RC, Romijn JA, Pereira AM (2010) Increased prevalence of psychopathology and maladaptive personality traits after long-term cure of Cushing’s disease. J Clin Endocrinol Metab 95:E129–E141

    Article  CAS  PubMed  Google Scholar 

  60. Lado-Abeal J, Rodriguez-Arnao J, Newell-Price JD, Perry LA, Grossman AB, Besser GM, Trainer PJ (1998) Menstrual abnormalities in women with Cushing’s disease are correlated with hypercortisolemia rather than raised circulating androgen levels. J Clin Endocrinol Metab 83:3083–3088

    CAS  PubMed  Google Scholar 

  61. Lindsay JR, Nansel T, Baid S, Gumowski J, Nieman LK (2006) Long-term impaired quality of life in Cushing’s syndrome despite initial improvement after surgical remission. J Clin Endocrinol Metab 91:447–453

    Article  CAS  PubMed  Google Scholar 

  62. Whirledge S, Cidlowski JA (2010) Glucocorticoids, stress, and fertility. Minerva Endocrinol 35:109–125

    PubMed Central  CAS  PubMed  Google Scholar 

  63. Shibli-Rahhal A, Van Beek M, Schlechte JA (2006) Cushing’s syndrome. Clin Dermatol 24:260–265

    Article  PubMed  Google Scholar 

  64. Davidovici BB, Orion E, Wolf R (2008) Cutaneous manifestations of pituitary gland diseases. Clin Dermatol 26:288–295

    Article  PubMed  Google Scholar 

  65. Minetto MA, Lanfranco F, Botter A, Motta G, Mengozzi G, Giordano R, Picu A, Ghigo E, Arvat E (2011) Do muscle fiber conduction slowing and decreased levels of circulating muscle proteins represent sensitive markers of steroid myopathy? A pilot study in Cushing’s disease. Eur J Endocrinol 164:985–993

    Article  CAS  PubMed  Google Scholar 

  66. Belaya ZE, Rozhinskaya LY, Melnichenko GA, Solodovnikov AG, Dragunova NV, Iljin AV, Dzeranova LK, Dedov II (2013) Serum extracellular secreted antagonists of the canonical Wnt/β-catenin signaling pathway in patients with Cushing’s syndrome. Osteoporos Int 24:2191–2199

    Article  CAS  PubMed  Google Scholar 

  67. Lekva T, Ueland T, Bøyum H, Evang JA, Godang K, Bollerslev J (2012) TXNIP is highly regulated in bone biopsies from patients with endogenous Cushing’s syndrome and related tobone turnover. Eur J Endocrinol 166:1039–1048

    Article  CAS  PubMed  Google Scholar 

  68. Barahona MJ, Sucunza N, Resmini E, Fernández-Real JM, Ricart W, Moreno-Navarrete JM, Puig T, Wägner AM, Rodriguez-Espinosa J, Farrerons J, Webb SM (2009) Deleterious effects of glucocorticoid replacement on bone in women after long-term remission of Cushing’s syndrome. J Bone Miner Res 24:1841–1846

    Article  CAS  PubMed  Google Scholar 

  69. Hermus AR, Smals AG, Swinkels LM, Huysmans DA, Pieters GF, Sweep CF, Corstens FH, Kloppenborg PW (1995) Bone mineral density and bone turnover before and after surgical cure of Cushing’s syndrome. J Clin Endocrinol Metab 80:2859–2865

    CAS  PubMed  Google Scholar 

  70. Kristo C, Jemtland R, Ueland T, Godang K, Bollerslev J (2006) Restoration of the coupling process and normalization of bone mass following successful treatment of endogenous Cushing’s syndrome: a prospective, long-term study. Eur J Endocrinol 154:109–118

    Article  CAS  PubMed  Google Scholar 

  71. Randazzo ME, Grossrubatscher E, Ciaramella PD, Vanzulli A, Loli P (2012) Spontaneous recovery of bone mass after cure of endogenous hypercortisolism. Pituitary 15:193–201

    Article  CAS  PubMed  Google Scholar 

  72. Koch CA, Tsigos C, Patronas NJ, Papanicolaou DA (1999) Cushing’s disease presenting with avascular necrosis of the hip: an orthopedic emergency. J Clin Endocrinol Metab 84:3010–3012

    CAS  PubMed  Google Scholar 

  73. Giovansili I, Belange G, Affortit A (2013) Cushing disease revealed by bilateral atypical central serous chorioretinopathy: case report. Endocr Pract 19:e129–e133

    Article  PubMed  Google Scholar 

  74. Giugni AS, Mani S, Kannan S, Hatipoglu B (2013) Exophthalmos: a forgotten clinical sign of Cushing’s syndrome. Case Rep Endocrinol. doi:10.1155/2013/205208

    PubMed Central  PubMed  Google Scholar 

  75. Wagenmakers MA, Netea-Maier RT, Prins JB, Dekkers T, den Heijer M, Hermus AR (2012) Impaired quality of life in patients in long-term remission of Cushing’s syndrome of both adrenal and pituitary origin: a remaining effect of long-standing hypercortisolism? Eur J Endocrinol 167:687–695

    Article  CAS  PubMed  Google Scholar 

  76. Alcalar N, Ozkan S, Kadioglu P, Celik O, Cagatay P, Kucukyuruk B, Gazioglu N (2013) Evaluation of depression, quality of life and body image in patients with Cushing’s disease. Pituitary 16:333–340

    Article  PubMed  Google Scholar 

  77. Tiemensma J, Kaptein AA, Pereira AM, Smit JW, Romijn JA, Biermasz NR (2011) Negative illness perceptions are associated with impaired quality of life in patients after long-term remission of Cushing’s syndrome. Eur J Endocrinol 165:527–535

    Article  CAS  PubMed  Google Scholar 

  78. Da Mota F, Murray C, Ezzat S (2011) Overt immune dysfunction after Cushing’s syndrome remission: a consecutive case series and review of the literature. J Clin Endocrinol Metab 96:E1670–E1674

    Article  PubMed  Google Scholar 

  79. Russo L, Vitti P, Pinchera A, Marinò M (2010) Exacerbation of autoimmune thyroiditis following bilateral adrenalectomy for Cushing’s syndrome. Thyroid 20:669–670

    Article  PubMed  Google Scholar 

  80. Peixoto I, Maquine G, Francesconi VA, Francesconi F (2010) Dermatophytosis caused by Tricophyton rubrum as an opportunistic infection in patients with Cushing disease. An Bras Dermatol 85:888–890

    Article  PubMed  Google Scholar 

  81. Scheffel RS, Dora JM, Weinert LS, Aquino V, Maia AL, Canani LH, Goldani LZ (2010) Invasive fungal infections in endogenous Cushing’s syndrome. Infect Dis Rep 2:e4

    Article  PubMed Central  PubMed  Google Scholar 

  82. Kronfol Z, Starkman M, Schteingart DE, Singh V, Zhang Q, Hill E (1996) Immune regulation in Cushing’s syndrome: relationship to hypothalamic-pituitary-adrenal axis hormones. Psychoneuroendocrinology 21:599–608

    Article  CAS  PubMed  Google Scholar 

  83. Faggiano A, Pivonello R, Melis D, Filippella M, Di Somma C, Petretta M, Lombardi G, Colao A (2003) Nephrolithiasis in Cushing’s disease: prevalence, etiopathogenesis, and modification after disease cure. J Clin Endocrinol Metab 88:2076–2080

    Article  CAS  PubMed  Google Scholar 

  84. Storr HL, Alexandraki KI, Martin L, Isidori AM, Kaltsas GA, Monson JP, Besser GM, Matson M, Evanson J, Afshar F, Sabin I, Savage MO, Grossman AB (2011) Comparisons in the epidemiology, diagnostic features and cure rate by transsphenoidal surgery between paediatric and adult-onset Cushing’s disease. Eur J Endocrinol 164:667–674

    Article  CAS  PubMed  Google Scholar 

  85. Dupuis CC, Storr HL, Perry LA, Ho JT, Ahmed L, Ong KK, Dunger DB, Monson JP, Grossman AB, Besser GM, Savage MO (2007) Abnormal puberty in paediatric Cushing’s disease: relationship with adrenal androgen, sex hormone binding globulin and gonadotrophin concentrations. Clin Endocrinol 66:838–843

    Article  CAS  Google Scholar 

  86. Keil MF (2013) Quality of life and other outcomes in children treated for Cushing syndrome. J Clin Endocrinol Metab 98:2667–2678

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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The authors declare that they have no conflicts of interest related to this manuscript.

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  1. Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Old Rd, Headington, Oxford, OX3 7LJ, UK

    Georgia Ntali, Ashley Grossman & Niki Karavitaki

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  1. Georgia Ntali
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  2. Ashley Grossman
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Correspondence to Niki Karavitaki.

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Ntali, G., Grossman, A. & Karavitaki, N. Clinical and biochemical manifestations of Cushing’s. Pituitary 18, 181–187 (2015). https://doi.org/10.1007/s11102-014-0631-4

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Keywords

  • Cushing’s syndrome
  • Hypercortisolemia
  • Cushing’s disease